Initiatives for addressing antimicrobial resistance in the environment: Current situation and challenges

Authors: AHAMMAD, SHAIKH - Indian Institute Of Technology; ARDUINO, MATTHEW - Centers For Disease Control And Prevention (CDC) - United States; DE RODA HUSMAN, ANA MARIE - National Institute For Public Health And The Environment (RIVM); Durso, Lisa; EDGE, THOMAS - Environment And Climate Change Canada; GARBER, GARY - Public Health Ontario; GARLAND, JAY - Environmental Protection Agency (EPA); GAZE, WILLIAM - University Of Exeter; GRAHAM, DAVID - Newcastle University; KIRBY, AMY - Centers For Disease Control And Prevention (CDC) - United States; LAPARA, TIMOTHY - University Of Minnesota; MCLAIN, JEAN - University Of Arizona; MCDONALD, CLIFFORD - Centers For Disease Control And Prevention (CDC) - United States; NAPPIER, SHARON - Environmental Protection Agency (EPA); PATRICK, DAVID - University Of British Columbia; ROUSHAM, EMILY - Loughborough University; STEKEL, DOV - University Of Nottingham; TOPP, EDWARD - Agriculture And Agri-Food Canada; VERNER-JEFFREYS, DAVID - Centre For Environment, Fisheries And Aquaculture Science (CEFAS); WITTUM, THOMAS - The Ohio State University; WONG, ALEX - Carleton University - Canada; AGA, DIANA - University Of Buffalo; DAVIES, JULIAN - University Of British Columbia; GANDRA, SUMANTH - Center For Disease Dynamics, Economics & Policy; KASPRZYK-HORDERN, BARBARA - University Of Bath; LARSSON, JOAKIM - University Of Gothenburg; SNAPE, JASON - Newcastle University; SLIJKHUIS, HERMAN - Dsm Sinochem Pharmaceuticals; SWEETMAN, ANDREW - Lancaster University; VOULVOULIS, NICK - Imperial College; BAYEN, STÉPHANE - McGill University - Canada; BEER, KARLYN - Centers For Disease Control And Prevention (CDC) - United States; DIRVEN, HUBERT - The Norwegian Institute Of Public Health; JACKSON, BRENDAN - Centers For Disease Control And Prevention (CDC) - United States; LEJEUNE, JEFF - The Ohio State University; Stockwell, Virginia; TIEDJE, JAMES - Michigan State University; PATEL, JEAN - Centers For Disease Control And Prevention (CDC) - United States

Submitted to: Electronic Publication
Publication Type: Other
Publication Acceptance Date: 11/30/2018
Publication Date: 12/11/2018
Citation: Ahammad, S.Z., Arduino, M., de Roda Husman, A., Durso, L.M., Edge, T., Garber, G., Garland, J., Gaze, W., Graham, D., Kirby, A., Lapara, T., McLain, J., McDonald, C., Nappier, S., Patrick, D., Rousham, E., Stekel, D., Topp, E., Verner-Jeffreys, D., Wittum, T., Wong, A., Aga, D., Davies, J., Gandra, S., Kasprzyk-Hordern, B., Larsson, J., Snape, J., Slijkhuis, H., Sweetman, A., Voulvoulis, N., Bayen, S., Beer, K., Dirven, H., Jackson, B., Lejeune, J., Stockwell, V.O., Tiedje, J., Patel, J. 2018. Initiatives for addressing antimicrobial resistance in the environment: Current situation and challenges. Available: https://wellcome.ac.uk/sites/default/files/antimicrobial-resistance-environment-report.pdf.

Interpretive Summary: As antimicrobial resistance in clinical bacteria and fungi has emerged, there is a need to examine possible sources of antimicrobials in the environment and antimicrobial resistance genes. The US Centers for Disease Control and Prevention, the United Kingdom Science and Innovation Network, and the Wellcome Trust cohosted a meeting to outline the current knowledge on these subjects. The report was drafted by invited technical experts and discussed at the meeting with the goals to summarize the current scientific knowledge on potential sources of antibiotics and resistant bacteria in the environment from human waste and animal manure disposal, manufacturing of antibiotics, and the use of antibiotics and triazole fungicides for disease prevention on crops. Methods to address detection of antimicrobials or antimicrobial resistance was summarized. Scientific knowledge gaps on the fate or risk of antimicrobials in the environment and the potential impact of enriched or introduced antimicrobial resistance in the environment on human health were identified.

Technical Abstract: The U. S. Centers for Disease Control and Prevention, the United Kingdom Science and Innovation Network, and the Wellcome Trust cohosted the International Environmental AMR Forum in Vancouver, B.C. on 4-5 April 2018. The goal of this meeting was to outline the current knowledge of how multiple sources of resistant bacteria and antibiotics, (i.e., human and animal waste disposal, antibiotic manufacturing, and the use of antibiotics as pesticides), contributes to the presence of resistant bacteria and antibiotics in the environment and the potential impact of the affected environment on human health. Scientific gaps in knowledge were identified, that are needed for governments to understand the risk to human health and steps needed to mitigate the risk, along with proposed pathways to fill these gaps. This report highlights data identifying the potential for the environment to be a source of AMR pathogens that can affect human health. The report also highlights knowledge gaps, which include the extent of environmental contamination, the source of contamination, the types of contamination that are most risky for human health, and which measures are most important for mitigating any risks. This report is intended as a roadmap for stakeholders including researchers, NGO’s, and countries to fill knowledge gaps and improve understanding on how to best evaluate and address AMR in the environment. Action is needed to fill these (knowledge) gaps and evaluate the potential risk of resistant bacteria and antimicrobials in the environment. Because the threat of AMR in the environment varies greatly from country to country, stakeholders should work to understand their local situation, determine what action is needed, and move towards reducing any identified risks to human health. As we improve our understanding of AMR in the environment, we will be able to better identify best practices, recommendations, and actions that are most consequential and should be considered for wider adoption.